AMA Speech - AMA National Conference 2015 - President's Statement

BRISBANE

FRIDAY 29 MAY 2015

**Check Against Delivery

Thank you to Uncle Eddie for his Welcome to Country.

We appreciate your welcome and acknowledge the traditional owners of the land, the Turrbal Aboriginal Nation. I pay respect to elders, both past and present.

Minister for Health, Sussan Ley, Shadow Minister for Health, Catherine King, delegates and attendees, colleagues - welcome to the 2015 AMA National Conference.

The AMA has faced one of its most difficult years, but also one of its most successful years.

When I was given the honour becoming AMA President this time last year, we faced an enormous task.

We had been blind-sided by a Federal Budget that was an unwarranted attack on GPs and other specialists, on hospitals, on health prevention and public health measures.

It was an assault on the Australian health care system. It was an attack on the health of our patients.

While these challenges seemed daunting, as doctors we are used to doing what is hard. 

Every day in our consulting rooms, in our hospitals, in our general practices, and in our operating theatres, we do what seems impossible.

We face challenges, we work together, and we don’t give up. We have taken this determination to fighting to improve our health system.

The most public and most important battle of the last 12 months has been the GP co-payment.

In the first week of being President, I went to see the then Health Minister, Peter Dutton.

I outlined our concerns and then I was presented a choice. The AMA could work with the Government, and support the co-payment proposal, and there may be some funding that the Minister had some discretion over, or we could simply oppose it – but the AMA would have to do that from the outside.

Well, that was no choice. It was no choice for the medical profession. We chose to oppose the GP co-payment proposal because it was bad policy.

It placed a financial barrier to accessing care for the sick and the vulnerable.

It went directly against all modern health policy by ignoring prevention and chronic disease management; and it jeopardised practices that served the most vulnerable and disadvantaged communities.

When I toured the Northern Territory visiting Aboriginal Medical Services, it was obvious that the co-payment would directly defund Indigenous health services. We were right to oppose bad policy.

However, the AMA did not blindly oppose the Government proposals. Rather, we went to the Prime Minister, we offered our help, and even, at his request, provided an alternative proposal. 

The AMA’s alternative proposal did include a co-payment for those patients who could afford to pay. It recognised the value of general practice and provided the investment that it needs. That proposal was ultimately treated with contempt.

We went on to defeat the introduction of the Government’s first co-payment proposal only to have a second, even worse, co-payment proposal put up in its place.

While some other GP organisations quickly and publicly supported the changes to the Level A and B fees, we took the time to ask our members what they thought.

Their response was immediate and overwhelming. The proposed changes to the Level A and B fees, combined with the Medicare rebate indexation freeze, were going to destroy their practices - and they were angry and ready to fight.

Armed with this support, I went to the media calling the changes a ‘wrecking ball’.

The strong and united voice of our members allowed me to speak for GPs everywhere.

We swung into campaign mode and GPs across the country galvanised into action. GPs met with local MPs, they signed petitions. During a few short weeks, more than 7000 emails were sent to MPs by GPs through the AMA’s ‘email your MP’ service.

GPs set up iPads on their reception desks to encourage patients to email MPs.

We did more than 600 media interviews and reached an audience of more than 44 million media consumers. 

In December last year, we had a new Minister for Health. In a pleasant change, we had a Minister who wanted to work with the AMA and other health groups.

We had a Minister who has been prepared to listen, and who understands that the AMA will work to support good policy. I thank the Minister for working with us.

Minister Ley announced that the changes to Level A and B would not proceed.

Likewise, shortly after the leadership spill motion, the Prime Minister and the Government decided not to proceed with the $5 co-payment proposal.

This was a victory for general practice and for our patients. It was a victory for the AMA.

I am proud of the hard work of my colleagues at Federal AMA, both in the leadership, such as Dr Steve Parnis and Dr Brian Morton, and our State AMA Presidents.

We are fortunate to have such dedicated and knowledgeable staff at the AMA who supported us.

But this was a victory for which all of the AMA should be proud – from grassroots members to our committee members and our councillors.

We have a long way to go to rebuild general practice.

The indexation freeze imposed by both sides of politics is harming general practice.

It is making it hard for GPs to decide if they can afford to take on a registrar or invest in more allied health or equipment or services.  

It hits hardest at practices and patients in disadvantaged areas. 

This cannot be allowed to continue. We need investment in general practice. With investment, GPs will continue their work in providing world class, patient-centred care.

With investment in general practice, there would be no need for fragmented care in pharmacies or other clinics.

So to Minister Ley and Shadow Minister King, I say to both of you if you want to improve care and drive lasting change in the health of all Australians, don’t waste your money on fragmenting care in other settings. Invest in general practice – general practice will deliver for you.

The indexation freeze is also impacting on specialists and their patients.

For private health insurers, there will be upward pressure on premiums as they index their own ‘no gap’ schedules, and absorb the lack of MBS indexation.

The only alternative for them is not to index, in which case patients’ out of pocket expenses for in-hospital procedures will skyrocket as the providers move away from ‘no gap’ arrangements.

The longer the freeze continues, the more damage is being done. And this is a question for both sides of politics.

While the co-payment has taken most of the airtime, we have not forgotten about the other cuts to health contained in the 2014 Federal Budget.

This is especially true of public hospital funding. This year, our annual Public Hospital Report Card rang the bell on the impending crisis facing our public hospitals.

We put the spotlight on the perfect storm of increasing demand for services, a system that is struggling to meet targets for performance, and a change to public hospital system funding.

The combination of these factors will have devastating consequences for our public hospital system.

Pushing responsibility for public hospital funding back to the States and Territories without remedies to allow them to generate revenue is irresponsible.

NSW Premier Mike Baird has said that this is the most significant finance issue - not just for health, but overall - facing States and Territories at this time.

I am even more worried about those smaller States and Territories with smaller economies, where patients’ access to services is not equitable with the larger States.

If the planned changes go ahead, there will be serious consequence for frontline clinical services.

Professionalism

The AMA is the peak body representing the medical profession. But what is a profession?

The Professional Standards Council describes a profession as a disciplined group of individuals who adhere to ethical standards, and possess special knowledge and skills in a widely-recognised body of learning derived from research, education, and training at a high level.

Importantly, however, a profession is also prepared to apply this knowledge and exercise these skills in the interest of others.

We apply our knowledge and skills to teaching medical students and training our successors.

We apply our expertise to health promotion and preventative health.

And we advocate for better health services and better access to health services.

When we are talking about professionalism and what it means to be a profession, we have to start by talking about looking after those starting out in our profession.

Starting my medico-political career as a medical student, I was angry that Governments are all too willing to use medical students and training as a political issue.

Like all doctors, I am concerned for our current medical students and trainees.

The doctor I am is a factor of the training and support I received as a medical student and a trainee.

I want the doctors and students of the future to benefit from this same strong collegiate training.

I don’t want students standing 5 or 6 deep around every patient, struggling for clinical experience. Our students and our patients deserve better.

We know medical students and trainees are already struggling to access required levels of clinical exposure.

Our trainees and students are already anxious about whether they will be able to get a training place and a job. 

It is for this reason that I was so angry about the announcement of the new clinical school at Curtin University.

I was also angry because the announcement was once again an instance of politics over policy.

Every expert review confirmed that a new medical school at Curtin would be bad for our health system.

I realise my language was strong and direct – I don’t apologise for that.

I will continue to support AMA WA and AMSA in speaking out strongly against this poor decision.

As doctors, we are also stewards of our health care system. We know that the Medicare Benefits Schedule is not always reflective of modern medical practice. We know that improvements can be made in primary care. That is why we are participating and supporting the Minister’s Medicare review.

Our support, as the Minister knows, is predicated on it being clinician-led, and on it leading to better outcomes for patients. It cannot be about a savings exercise, or about taking access to vital services away from patients.

But we will be there, as long as it delivers good health policy for our patients.

Fighting for our patients and our health care system has been one part of being the AMA President.

Speaking up for those without a voice

However, another key role is the power to stand up for those who cannot speak for themselves.

I used my first speech to the AMA Parliamentary Dinner last year to explain to politicians why I and my colleagues become advocates.

I told the story of the days in the Children’s Hospital Emergency Department when I saw once again the death and destruction caused by road trauma.

It was not the first time I had seen that trauma, nor would it be the last - and it was a trauma that would be all too familiar to all of you.

Those experiences led to the Don’t Rush road safety campaign. 

The power to speak for those who cannot speak for themselves is one of the great privileges of being a doctor.

It is a privilege we can exercise every day in large or small ways. It is the basis of much of our public health advocacy.

It is the reason I felt compelled to speak out so strongly on Ebola. 

It has been suggested that I spoke out on Ebola on the basis of party politics. I spoke out on Ebola simply because it was the right thing do to.

I was sitting at home one night watching CNN and I saw the coverage of the crisis in West Africa. The images were horrifying. Adults and children were wandering the streets, many were naked because of their persistent gastro symptoms.

There was no care for them and they were simply being left to die, as they were, in the streets.

I also saw the evidence from the experts that if Ebola was not managed and contained in West Africa, it would become a serious health risk for Australia and other countries.

At the same time, my colleagues in Australian hospitals were calling me to tell me that the preparations in Australia were also not sufficient. 

Australia has a proud history of contributing to international disasters. We do so despite distance and our small population.

My call to the Australian Government was to simply allow those doctors and nurses who wanted to serve to do so.

I acknowledge that the Government did step up and join the international effort, and that this has made a significant difference to the people of West Africa.

Public health

We have also been active on public health for Australians.

We held a major Alcohol Summit last year to highlight the impact of alcohol on the health of Australians.

We have supported improved vaccination rates, end of life care, and organ donation. At this Conference, we will launch a national resource for doctors on domestic violence.

We have also talked about the health impacts of climate change. This is an issue that always gets lots of letters and comment.

I have come to realise some AMA members and many members of the public don’t like us talking about climate change. However, our job is to look at the evidence and to speak to that evidence.

We proudly stood beside the Australian Academy of Science to support their evidence on vaccination. We cannot then stand by and refuse to acknowledge the same body’s scientific evidence on climate change.

Where there is evidence of health impacts, we will speak because that is what is right. That’s what the AMA does.

Another quality of a profession, and this must be particularly true of the medical profession, is that individuals care for each other as colleagues.

Collegiality in medicine

The responsibility of collegiality is especially important for our young colleagues, our doctors in training and our students. We must protect and nurture them as our junior colleagues.

In recent months, we have seen coverage of the impact on our colleagues who have not received that care and support, or who have been directly sexually harassed or bullied.

On behalf of the AMA, I say again to you all that sexual harassment and bullying are unacceptable.

The AMA firmly rejects any behaviour that bullies or intimidates people, whether it is on the basis of gender or any other reason.

A number of colleagues have written to me to share their stories.

While this issue is challenging, it is an issue that the profession must confront.

I was pleased to have 40 colleagues representing Colleges and other organisations attend the AMA Roundtable on Sexual Harassment in Canberra recently.

While the issues of harassment have been prominent in the media, achieving cultural change is not just about stopping bullying and harassment.

It is about promoting female leaders and championing gender equality.

It is about ensuring that all doctors – male and female – can access appropriate parental leave and, if they wish, flexible work arrangements.

We will also continue our role in supporting doctors and students at an individual level.

I have said many times that some of my proudest moments as a State AMA President were when the AMA advocated successfully on behalf of individuals - particularly when they find themselves in difficult circumstances, often not of their own making.

This has also been a core part of my Federal Presidency. This is an important role for the AMA, and one we will continue.

The AMA Presidency is, at times, a great responsibility.  It also brings some great privileges in terms of unique experiences in other countries and in our own.

I was honoured to travel with AMA NT President Dr Rob Parker through the Tiwi Islands. I saw first-hand the determination of these proud people to take care of their community.

I have also travelled to Alice Springs and visited services such as those at the Central Australian Aboriginal Congress and the Amoonguna Aboriginal Medical Service.

Indigenous health remains a critical issue for Australia.  We still have far too long to go to Close the Gap.

However, while there is much to despair about, I have also tried to promote the achievements and strengths of Indigenous communities – the vaccination programs, the antenatal care, the comprehensive primary care provided by AMSs, and so much more.

I am looking forward to continuing to work with the Indigenous Health sector.

As President, I have been fortunate to speak at the BMA Conference on the Social Determinants of Health.

This also involved the chance to have dinner at the House of Lords and to receive a personal tour thanks to the BMA President, Baroness Ilona Finlay, and her husband, Andrew.

I represented the AMA in an ANZAC Service in Gallipoli. I was truly humbled by the hospitality shown by my Turkish Medical Association hosts.

The doctors of the Turkish Medical Association welcomed me as one of their own. Despite limited shared language, we shared the bonds of medical colleagues and our desire to honour our colleagues who had died in wars, and the soldiers they had cared for.

I have also travelled to the US for a series of meetings on the US health care system.

While US-style care is used as shorthand for expensive, inappropriate care, it was interesting to see the many innovative models of health care in the US, particularly with integrated primary care.

In all of my travels, I have been struck by the commonality of the issues facing the medical profession.

And I have been struck by the shared bonds of our colleagues working across the world seeking to provide the best possible care to their patients.

Last year, the AMA National Conference Delegates voted for historic Constitutional change.

We talked about an AMA Council and Committee structure that allowed for pro-active policy development, that was more balanced, and which facilitated policy development.

The Federal Council has a new Committee structure, and it is delivering the policy development that we are aiming for.

The Federal Council, under the guidance of Dr Beverley Rowbotham as Chair, has focused on policy.

The agendas are full of policy discussion and debate. This is exactly what the Federal Council should be doing.

We are making it more representative, and recently voted to make the Rural Medicine Committee a Council member, with its Chair a full member of Council – a change that was overdue.

Is there more to do? Yes. Have we finished the task? No, we haven’t. But the change that you voted for last year has made an enormous impact.

Likewise, the Board of Federal AMA has set about its work. We have a strategic plan and an operational plan.

These were also issues that we talked about at last National Conference.

The Chair of our Board, Dr Liz Feeney, and our Secretary General, Ms Anne Trimmer, have worked hard at ensuring the new structure works for the AMA.

The Board is focused on corporate governance. It has addressed a wide range of issues that the AMA had not focused on previously.

But there are changes that are being made that members will start to notice. The hard copy of Australian Medicine is just one such change.

Membership remains a challenge for any membership organisation, but we continue to grow - and we have a plan to grow membership further.

Colleagues, the past year has been challenging for the AMA on many fronts.

As an organisation, the AMA has risen to these challenges - challenges that we have more than met. But there are more challenges ahead.

What I know is that the AMA will be where it should be. At the front, leading.

Leading from the front is sometimes hard. This last year has been hard at times. The year ahead will be just as hard. But the AMA does not stop when it gets hard.

As doctors, we consider the evidence, and take a position. We will work for good policy.

But when there is bad policy, when it affects our members’ ability to practise good medicine, when it adversely affects our patients, we will say so without fear or favour, just as we have done this year.

The AMA does not stop because it gets hard.

We have fought hard for our members. We have fought hard for our patients. And we have been successful. I am proud of the past year and the AMA’s achievements, and you should be too.

Thank you for your support during this year – both professionally and personally. I look forward to a successful AMA National Conference.

29 May 2015

CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                            Odette Visser                      02 6270 5412 / 0427 209 753